Jugular Vein Research Articles

Evaluation of a novel central venous access port for direct catheter insertion without a peel-away sheath.

This study retrospectively evaluated the feasibility and safety of implanting a newly developed central venous access port (CV-port) that allows catheter insertion into a vein without the use of a peel-away sheath, with a focus on its potential to minimize risks associated with conventional implantation methods. All procedures were performed using a new device (P-U CelSite Port™ MS; Toray Medical, Tokyo, Japan) under ultrasound guidance. The primary endpoint was the implantation success rate. The secondary endpoints were the safety and risk factors for infection in the early postprocedural period (< 30days). We assessed 523 CV-port implantations performed in a cumulative total of 523 patients (240 men and 283 women; mean age, 61.6 ± 13.1years; range, 18-85years). All implantations were successfully performed using an inner guide tube and over-the-wire technique through 522 internal jugular veins and one subclavian vein. The mean procedural time was 33.2 ± 10.9min (range 15-112min). Air embolism, rupture/perforation of the superior vena cava, or hemothorax did not occur during catheter insertion. Eleven (2.1%) intraprocedural complications occurred, including Grade I arrhythmia (n = 8) and subcutaneous bleeding (n = 1), Grade II arrhythmia (n = 1), and Grade IIIa pneumothorax (n = 1). Furthermore, 496 patients were followed up for ≥ 30days. Six early postprocedural complications were encountered (1.1%), including Grade IIIa infection (n = 4), catheter occlusion (n = 1), and skin necrosis due to subcutaneous leakage of trabectedin (n = 1). These six CV-ports were withdrawn, and no significant risk factors for infection in the early postprocedural period were identified. The implantation of this CV-port device demonstrated comparable success and complication rates to conventional devices, with the added potential benefit of eliminating complications associated with the use of a peel-away sheath.

Cold Pressor Test Induces Significant Changes in Internal Jugular Vein Flow Dynamics in Healthy Young Adults.

BACKGROUND The cold pressor test (CPT), which has long been used to test autonomic functions by causing sympathetic excitation, increases systolic and diastolic blood pressure and heart rate and causes coronary vasodilation within physiological limits in healthy individuals. This study aimed to evaluate internal jugular vein (IJV) flow parameters using the CPT with systolic and diastolic blood pressure and heart rate in 40 healthy volunteers aged 18-40 years. MATERIAL AND METHODS The volunteers' IJV diameter, blood flow peak velocity, and volumetric flow values were recorded. Then, their right hands were immersed in a bucket of cold water maintained at 1°C up to the wrist level. At the end of the first minute (CPT-1), systolic and diastolic blood pressure, heart rhythm, IJV diameter, peak velocity, and volumetric flow measurements were performed again. RESULTS Systolic and diastolic blood pressure values were significantly higher at CPT-1 compared to baseline values (P<0.001, P<0.001). Heart rate and peak velocity values also showed a significant increase at CPT-1 compared to baseline values (P<0.001, P=0.001). While diameter values showed a significant decrease compared to baseline, volumetric flow rate values showed a significant increase at CPT-1 (P=0.003, P<0.001). CONCLUSIONS Sympathetic nervous system activation triggered by CPT increases IJV volumetric flow and flow velocity in healthy young individuals, and sympathetic nervous system activation causes a venoconstrictive effect in the IJV.

Isolated external jugular thrombophlebitis secondary to acute pharyngitis: a case report and a review of the literature

BackgroundExternal Jugular Thrombophlebitis (EJT) is a rare clinical phenomenon with few reports in the literature, especially in the pediatric population. This is a report of an unusual case of right-sided EJT in a pediatric patient secondary to acute pharyngitis with sinusitis most prominent on the left side.Case presentationA 13-year-old presented to the emergency department with worsening upper respiratory infectious (URI) symptoms and facial swelling, cough, throat pain, and emesis. The patient had traveled to Switzerland and received amoxicillin for strep throat 6 weeks before this hospitalization. Physical examination revealed nasal purulence, allodynia over the right side of the face without overlying erythema, and oropharyngeal exudate. CT scan revealed left-sided predominate sinusitis and right external jugular vein thrombosis. Blood cultures confirmed the presence of group A streptococcus infection. Treatment included IV antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), IV steroids, and anticoagulation. Follow-up imaging demonstrated improvement in thrombosis, cellulitis, and sinus disease. The patient was discharged on antibiotics for 6 weeks and anticoagulation for 10 weeks. Follow-up imaging at 6 months revealed no EJT, and medications were discontinued.ConclusionsEJT is a rare condition, and to our knowledge, no reports of EJT with sinusitis most pronounced on the contralateral side have been published. Physicians will benefit from noting clinical signs of EJT such as facial edema, headache, erythema, and palpable neck mass, especially if these symptoms occur with URI symptoms refractory to treatment. The use of anticoagulation is controversial for internal jugular vein thrombosis, and while no guidelines for EJT exist, anticoagulation is likely not necessary save for severe complications.

Effects of Supplementing Different Quantities of Moringa stenopetala Leaves on Plasma Metabolite and Acylcarnitine Profile, Body Condition Score and Milk Yield Performance in Zebu (Bos indicus) Cattle.

The formulation of multi-nutrient blocks based on low-cost and locally available browse feed resources can be a valid feeding strategy in Sub-Saharan Africa, where inadequate feed supply, both in quality and quantity, is a major constraint. We evaluated the four different inclusion percentages (M-0%, M-25%, M-35% and M-45%) of Moringa stenopetala leaf powder to multi-nutrient blocks on their change on blood metabolite of dairy cows under practical, ranging conditions. Multi-nutrient blocks with four inclusion rates of M. stenopetala leaves were applied as complementary feed for free ranging dairy cows. The study was performed on 24 free ranging dairy cows reared around Arba Minch town in the Southern Ethiopian Rift Valley. Blood samples were collected from the jugular vein of dairy cows both before and after supplementation. Plasma glucose, beta hydroxy butyrate (BHB), urea, creatinine, triglycerides and nonesterified fatty acids (NEFA) concentration was quantified spectrophotometrically. Dried serum spots were subject to quantitative electrospray tandem mass spectrometry to estimate changes in nutrient metabolism based on selected carnitines. Based on these measurements, the milk yield and body condition score were increased during the period of multi-nutrient block supplementation. During the supplementation period, the cows got higher plasma glucose, triglyceride and urea concentrations and lower concentrations of BHB, NEFA and creatinine. From the metabolite profiles, a more efficient nutrient use could be concluded. Although no clear dose-response relationship was observed, the highest inclusion of the M. stenopetala leaves in the multi-nutrient blocks gave the best performance. This outcome supports the idea of implementing M. stenopetala based multi-nutrient blocks on tropical smallholder farms that are not easily accessible to conventional extension services.

PSII-18 Prematurity alters nutrient signaling and protein synthesis in skeletal muscle of neonatal piglets

Abstract Extrauterine growth restriction is common in infants born preterm, and negatively affects lean mass accretion and health. Prematurity has been shown to inhibit the feeding-induced stimulation of protein synthesis in skeletal muscle. We hypothesized that nutrient signaling, activation of the mechanistic target of rapamycin complex 1 (mTORC1), and protein synthesis in the muscle are limited in preterm infants which negatively impacts muscle growth. The objective of this study was to examine how prematurity influences the mechanisms involved in insulin- and amino acid-induced signaling and protein synthesis in skeletal muscle of piglets delivered either 9 d preterm (104 d, n = 25) or at term (112 d, n = 26) by cesarean section. After resuscitation, they were surgically implanted with jugular vein and carotid artery catheters and placed in individual incubators. They were randomly allotted to one of three treatments within each preterm and term birth groups: euaminoacidemic-euglycemic (FAST), hyperinsulinemic-euaminoacidemic-euglycemic (INS), or euinsulinemic-hyperaminoacidemic-euglycemic (AA) clamps on 4 d after birth. After the clamp procedure, the piglets were euthanized to collect longissimus dorsi muscle for estimating in vivo fractional protein synthesis rates and the abundance and activation of components related to insulin and amino acid signaling. Data were analyzed using the MIXED procedure of SAS. The leucine sensor, Sestrin1 bound to GATOR2 (P &amp;lt; 0.05) was reduced in response to AA whereas the abundance of the mTOR-RagA and mTOR-RagC complexes increased (P &amp;lt; 0.05). The phosphorylation of Akt was increased (P &amp;lt; 0.05) in response to INS and the phosphorylation of mTORC1 and protein synthesis increased (P &amp;lt; 0.05) in response to both AA and INS. Prematurity did not affect the protein abundances of the AA transporters for glutamine (SLC38A2), leucine (SLC7A5), and arginine (SLC38A9). However, prematurity reduced (P &amp;lt; 0.05) the abundances of the leucine sensors SAR1B, the Sestrin1-GATOR complex, the AA sensor, RAB1A, and the threonine sensor, TARS2 (P &amp;lt; 0.05). The abundances of the glutamine sensor, ARF1, the arginine sensor, CASTOR, and the methionine-SAMTOR GATOR complex were similar. Prematurity reduced (P &amp;lt; 0.05) the abundance of the mTOR-RagA and mTOR-RagC complexes, the phosphorylation of mTORC1 and muscle protein synthesis (P &amp;lt; 0.05). In conclusion, prematurity negatively affects protein synthesis in skeletal muscle of neonatal preterm piglets by blunting anabolic pathways responsible for nutrient-sensing and mTORC1 activation. The reduced anabolic response likely contributes to reduced lean growth and extrauterine growth restriction following preterm birth.

PSXI-18 Effects of different fiber levels on rumination and inflammatory markers in feedlot cattle

Abstract Adding fiber to feedlot diets is essential to maximize performance, optimize feed conversion and maintain animal health. Monitoring blood inflammatory markers and rumination behavior can help to identify fiber levels that maximize performance and animal well-being. We aimed to evaluate the effect of fiber levels on inflammatory markers, lactate dehydrogenase and haptoglobin and rumination of Nellore cattle in confinement fed with diets containing 12% and 7% forage NDF, over a period of 50 d. Diets included corn silage as the source of forage fiber with 23.3% and 13.6% corn silage in the dry matter 64% and 73.5% ground corn, and 0.2 and 0.5% potassium chloride, respectively for the 12% and 7% fNDF. Soybean meal (1.5%); cottonseed (7%), urea (1.2%), and mineral mixture (2.7%) containing 25 ppm of monensin were present in both treatments. Average initial body weight (BW) was 460 ± 38 kg and average age was 20 mo. Bulls (n = 20) were randomly distributed for each treatment with animal being the experimental unit. The feeding behavior was monitored on d 21 and 42, with observations at each 10-min interval, over 24 h and data obtained were averaged for analysis and blood samples were collected immediately after behavior analysis. Blood samples were obtained by puncturing the jugular vein, centrifuged to separate the serum, stored at -20°C and subsequently analyzed. Lactate dehydrogenase was analyzed in an automatic biochemistry system using cattle specific cattle kits (LABTEST Diagnóstica SA). Haptoglobin analyses were carried out by ELISA (Vidavet-Veterinary Lab). Data were evaluated by PROC GLIMMIX from SAS. A significant interaction was observed between minutes of rumination and fNDF levels in relation to the concentration of lactate dehydrogenase (P &amp;lt; 0.0001), expressed by the solution: Lactate = 1,272.12 + 908.86 * (tract = 7) + 1,1427 -3.3170 * (treat = 7) * rumination. For animals receiving the 7% fNDF diet, the concentration of lactate dehydrogenase decreased as the minutes of rumination increased, with a significant linear effect (P &amp;lt; 0.001). On the other hand, for animals treated with 12% fNDF, no significant correlation was observed (P = 0.34) with increasing rumination time. There was also an interaction between minutes of rumination and fNDF levels for haptoglobin concentration (P &amp;lt; 0.01), expressed by the solution: Haptoglobin = 0.1901 + 0.4865 * (treat = 7) + 0.000828 - 0.00163 * (treat = 7) * rumination. In animals treated with 7% fNDF, haptoglobin concentration decreased with increasing minutes of rumination, with a significant linear effect (P = 0.02). Our data demonstrates that, for the low forage diet, as bulls increased rumination time there was an improvement (a decrease) in inflammatory markers concentrations.

Outcomes in peripheral right ventricular device support: Comparing the dual lumen, single canula and femoral vein cannulation strategies for right ventricular support.

The Protek Duo (PtD) dual lumen, single cannula was developed as a percutaneous system for temporary mechanical support, inserted through the internal jugular vein (IJ) for both atrial inflow and pulmonary artery outflow. Outcomes of PtD compared to alternative Peripheral Right Ventricular Assist Device (pRVAD) methods are limited. A retrospective analysis was conducted of pRVAD recipients from January 2017 - February 2022 (n = 111). These were classified into PtD (n = 52) patients and Non-Protek [(N-PtD) (n = 59)] recipients undergoing cannulation of the IJ and femoral vein. Results were further stratified by indication for pRVAD support: cardiogenic etiologies of heart failure and progressive ARDS. No survival benefit was detected between PtD and N-PtD groups at 1-week (OR: 1.32, 95% CI: 0.49-3.56, p = 0.58) or 6-month (OR: 9.83, 95% CI: 0.37-1.84, p = 0.64) follow-up. There were no statistically significant differences in whether patients' mobility progressed to out-of-bed activity (p = 0.26) or ambulation (p = 0.38). No differences were noted in time to out-of-bed (p = 0.26) or time to ambulation (p = 0.36). On subgroup analysis of patients by indication for pRVAD cannulation, these results persisted; no difference was noted in mid-term mortality (Cardiogenic: p = 0.39; ARDS: p = 0.91), progression to out-of-bed (p = 0.59; p = 1.00), or ambulation (p = 0.51; p-0.68). Among secondary outcomes, PtD patients had an increased dialysis requirement (p = 0.02). There were no differences in ability to wean from RVAD (p = 0.06), tracheostomy (p = 0.88), major bleeding events (p = 0.57), stroke (p = 0.58), or hospital length of stay (p = 0.39). Outcomes with PtD are comparable to those of traditional pRVAD cannulation strategies. Of note, no mobility benefit was observed to the use of PtD across several metrics.

Impact of Ultrasound Scanning Plane on Common Carotid Artery Longitudinal Wall Motion

ObjectiveThe arterial wall not only moves in the radial direction to expand circumferentially but also moves in the axial (longitudinal) direction in a predictable bidirectional pattern during a normal cardiac cycle. While common carotid artery (CCA) longitudinal wall motion (CALM) has been described previously, there is a lack of evidence-based method standardization to align practices for human measurement. The purpose of this study was to evaluate whether different scanning planes impact CALM outcomes in healthy males and females to provide clarity on data collection strategies. MethodsThirty-one healthy adults (16 females, 23 ± 3 y of age) underwent ultrasound scanning of the right CCA in the anterior, lateral, and posterior imaging planes. CALM was evaluated using a custom speckle-tracking algorithm and was analyzed as segmental motion outcomes (anterograde, retrograde, maximum displacement and radial-axial path length). ResultsNo differences in any CALM outcome were observed between imaging planes (p > 0.05), and equivalence testing indicated that retrograde CALM displacement was similar between anterior and posterior distal walls (p = 0.04). We observed no differences (p > 0.05) in CALM outcomes between the proximal (free-wall, adjacent to the internal jugular vein [IJV]) and distal wall in the posterior imaging plane. Qualitatively, it was more difficult to successfully track vascular tissue between the IJV and CCA due to the thin wall components and highly mobile wall in the radial direction. ConclusionIn the absence of clear differences between scanning planes, we recommend standardizing acquisition in the lateral plane and avoiding the IJV free-wall when evaluating CALM in humans.

Monitoring Blood-Brain Barrier Opening in Rats with a Preclinical Focused Ultrasound System.

The brain has a highly selective semipermeable blood barrier, termed the blood-brain barrier (BBB), which prevents the delivery of therapeutic macromolecular agents to the brain. The integration of MR-guided low-intensity pulsed focused ultrasound (FUS) with microbubble pre-injection is a promising technique for non-invasive and non-toxic BBB modulation. MRI can offer superior soft-tissue contrast and various quantitative assessments, such as vascular permeability, perfusion, and the spatial-temporal distribution of MRI contrast agents. Notably, contrast-enhanced MRI techniques with gadolinium-based MR contrast agents have been shown to be the gold standard for detecting BBB openings. This study outlines a comprehensive methodology involving MRI protocols and animal procedures for monitoring BBB opening in a rat model. The rat model provides the added benefit of jugular vein catheter utilization, which facilitates rapid medication administration. A stereotactic-guided preclinical FUS transducer facilitates the refinement and streamlining of animal procedures and MRI protocols. The resulting methods are characterized by reproducibility and simplicity, eliminating the need for specialized surgical expertise. This research endeavors to contribute to the optimization of preclinical procedures with rat models and encourage further investigation into the modulation of the BBB to enhance therapeutic interventions in neurological disorders.

Vascular Access for Renal Replacement Therapy in Neonates and Infants: A Single Center Experience

IntroductionNeonatal renal replacement therapy (RRT) is a treatment modality used for severe kidney failure. Historically, its use has been limited in small infants due to circuits with large extra-corporeal volumes that require large double lumen vascular catheters. We sought to review our institution's experience with vascular access and overall survival in infants who receive RRT. MethodsA retrospective chart review of infants less than 5 kg (kg) was performed at our free-standing children's hospital from January 2016 to July 2023. We assessed the number of catheters used per patient, location of catheter placements, size of catheter, duration of treatment, reasons for line removal, and mortality. ResultsA total of 93 neonatal patients were identified who underwent RRT. Thirty-two patients (34.4%) required more than one catheter, with a total of 145 catheters placed for this cohort. The median (IQR) weight at insertion was 3.3 kg (2.7–4.0). The most common location for placement was the right internal jugular vein (n = 114, 78.6%). Patients required catheters for RRT for a median (IQR) of 16 days (7–39). Six patients underwent catheter placement at a weight of less than 2 kg. Nineteen total patients went on to peritoneal dialysis (20.4%). Fifty-three patients died during their admission (57.0%). ConclusionTo our knowledge this is the largest review of catheter use for RRT in infants within an intensive care unit and it reveals the success in treating renal failure in even the smallest infants. Level of EvidenceIV, Treatment Study.

Pulmonary Artery Endograft Implantation Using a Parallel Stent Grafting Technique to Enable the Treatment of a Bronchial Anastomosis Complication After Lung Transplantation.

Bronchial stenosis associated with bronchial anastomosis dehiscence after lung transplantation is a catastrophic complication following lung transplantation with a paucity of therapeutic solutions. To describe an adaptation of the parallel stent grafting technique in the pulmonary arterial territory to treat this challenging situation. This is a case report of a 52-year-old patient who presented bronchus stenosis and bronchial anastomosis dehiscence after lung transplantion. Bronchial stenting and lung retransplantation were contraindicated. Therefore, an endovascular approach using pulmonary artery endograft placement to prevent bleeding during repeated right bronchial balloon dilation was propposed. The technique consists of the deployment of an aortic extender endoprosthesis in the right main pulmonary artery and a balloon expandable stent in the upper lobe pulmonary artery (using a parallel graft configuration) through the common femoral and right internal jugular veins, respectively. Intraoperative transesophageal echocardiogram and one-lung ventilatory ventilation are needed. The patient underwent a new bronchoscopy 16 days after the procedure, that showed epithelization at the previous eroded zone, enabling bronchocopic balloon dialtion to be safely performed. A post-operative contrast-enhanced CT scan revealed an adequate positioning of the stent grafts. Despite all eforts, the patient succumbed to ventilator associated pneumonia on postoperative day 108. The technique's advantages include its feasibility even in situations in which other techniques may be contraindicated and its potential use in emergencies. Its limitations include the need for experienced interventionists to perform it, and the potential risk of acute tricuspid regurgitation. This study illustrates the early feasibility of the parallel stent grafting technique applied to the pulmonary artery territory. However, it's safety profile regarding infectious risk was not demontrated.

Elevated systemic venous pressures as a possible pathology in prepubertal pediatric idiopathic intracranial hypertension.

Pediatric idiopathic intracranial hypertension (IIH) is a rare and challenging condition. As implied by the nomenclature, the etiologies remain unknown, and multiple etiologies are being investigated. In this study, we explored the potential role of increased systemic or cerebral venous pressure in the pathogenesis. An observational cohort study following the STROBE guidelines, including prepubertal children with clinical symptoms and imaging findings consistent with IIH referred to the neurosurgical department, was conducted. The patients underwent a comprehensive diagnostic protocol, including MRI, continuous intracranial pressure (ICP) monitoring, and endovascular venography with venous pressure measurements. The study included 11 consecutive patients (six boys and five girls) with an average age of 2.3years, and an average BMI of 18.4. Among these, one patient was found to have venous stenosis with a gradient; the other 10 patients presented with normal intracranial anatomy. All patients exhibited elevated venous pressures, with an average superior sagittal sinus pressure of 18.9mmHg, average internal jugular vein pressure of 17.0mmHg, and average central venous pressure of 15.9mmHg. Daytime ICP averaged 12.9mmHg, whereas nighttime ICP averaged 17.2mmHg with either A- or B-waves in 10 of the 11 patients. Despite pathological ICP, only three patients had papilledema. All patients had an increased systemic venous pressure, indicating a possible pathological factor for prepubertal IIH. Additionally, our findings show that young children often only partly meet the Friedman criteria due to a lack of papilledema, emphasizing the need for pediatric-specific diagnostic criteria. Further large-scale studies are needed to confirm these findings and to explore the underlying reasons for this increase in venous pressure and potential new treatment avenues.

Lemierre’s Syndrome – Case Report of a 20-Year-Old Male with Post-Anginal Sepsis

&lt;b&gt;Introduction:&lt;/b&gt; Lemierre’s syndrome, first described by André Lemierre in 1936, is a rare but life-threatening condition. It is characterized by a triad of symptoms: pharyngeal infection, internal jugular vein thrombosis, and sepsis with distant abscesses, usually in the lungs. The primary pathogen is the anaerobic Gram-negative bacterium &lt;i&gt;Fusobacterium necrophorum&lt;/i&gt; (&lt;i&gt;F. necrophorum&lt;/i&gt;). In recent years, there has been an increase in the incidence of Lemierre’s syndrome.&lt;b&gt;Case report:&lt;/b&gt; A 20-year-old male was admitted to the Emergency Department (ED) with jaundice, dyspnea, sore throat, fever up to 39C, neck pain, and left lower limb weakness. Examination revealed enlarged palatine tonsils with purulent exudates and a right-sided peritonsillar abscess. Laboratory tests showed elevated inflammatory markers, thrombocytopenia, and leukocytosis. Computed topography (CT) confirmed internal jugular vein thrombosis, abscesses in the right sternocleidomastoid muscle, and bilateral pleural effusions. The patient received oxygen therapy, antibiotics, anticoagulation, and pleural drainage. After 26 days of hospitalization, he was discharged with a recommendation to continue antibiotic therapy and low-molecular-weight heparin, as well as planned removal of the palatine tonsils (tonsillectomy).&lt;b&gt;Discussion:&lt;/b&gt; Lemierre’s syndrome is a severe complication of upper respiratory tract infections, mainly affecting young individuals. Symptoms include pharyngeal infection, sepsis, and internal jugular vein thrombosis. Early diagnosis and appropriate treatment, including prolonged antibiotics and sometimes anticoagulation, are crucial. The rise in incidence may be linked to the irrational use of antibiotics. Educating clinicians is vital to improve outcomes and reduce complications.&lt;b&gt;Conclusions:&lt;/b&gt; Initial symptoms of Lemierre’s syndrome are nonspecific, complicating early diagnosis. Neck imaging and/or positive blood cultures are key for diagnosis. The incidence is 1–2.5 cases per million annually, making it rare but potentially fatal. Mortality before antibiotics was around 90%; currently, it is 5–18%, but higher without proper diagnosis. Early imaging significantly improves prognosis.

A Rare Case of External Jugular Vein Aneurysm Mimicking Branchial Cyst in a Nigerian Child

Abstract Background: An aneurysm of the external jugular vein is exceptionally rare. Its occurrence in children could present diagnostic challenges due to numerous potential differential diagnoses, including anomalies such as branchial cysts. Objective: This study aims to emphasize the necessity of raising suspicion for jugular venous aneurysms in children with cystic neck masses. Case Summary: We report an 18-month-old boy with a left-sided neck swelling persisting for 10 months. The swelling was cystic and increased in size during straining or crying. A preoperative diagnosis of a branchial cyst was made but was inconsistent with intraoperative findings, where a venous aneurysm was diagnosed. Ligation and excision were performed without sequelae. Conclusion: External jugular venous aneurysms, though rare, should be considered as a potential differential diagnosis in case of lateral neck swellings, especially if they demonstrate compressibility with an increase in size on Valsalva maneuvers. Simple ligation and excision are curative measures.

Post-acute sequelae of COVID infection and cerebral venous outflow disorders: Overlapping symptoms and mechanisms?

Neurological long Covid (NLC) is a major post-acute sequela of SARS-CoV-2 infection, affecting up to 10% of infected patients. The clinical presentation of patients with NLC is varied, but general NLC symptoms have been noted to closely mimic symptoms of cerebral venous outflow disorders (CVD). Here we review key literature and discuss evidence supporting this comparison. We also aimed to describe the similarity between CVD symptomatology and neuro-NLC symptoms from two perspectives: a Twitter-distributed survey for long covid sufferers to estimate nature and frequency of neurological symptoms, and through a small cohort of patients with long covid who underwent CVD work up per our standard workflow. Over 700 patients responded, and we argue that there is a close symptom overlap with those of CVD. CVD workup in a series of 6 patients with neurological long COVID symptoms showed jugular vein stenosis by CT venography and varying degrees of increased intracranial pressure. Finally, we discuss the potential pathogenic association between vascular inflammation, associated with COVID-19 infection, venous outflow congestion, and its potential involvement in NLC.

A Study of Tpeak-Tend/QT Interval Ratio in Predicting Heart Failure in ST-Elevation Myocardial Infarction and Its Correlation With N-terminal Pro B-type Natriuretic Peptide (NT-proBNP).

Background Acute ST-elevation myocardial infarction (STEMI) is the most common cause of mortality across the world. The electrocardiogram (ECG) Tpeak-Tend/QT interval appears to be a measure of the left ventricle's transmural dispersion of repolarization (TDR). Prolongation of this time could indicate adverse cardiac events like heart failure, arrhythmias, etc. Heart failure is a clinical syndrome that includes signs and symptoms such as peripheral edema and high jugular vein pressure. N-terminal pro B-type natriuretic peptide (NT-proBNP) is an effective predictor of left ventricular function and also helps in predicting the disease prognosis. Elevated levels of NT-proBNP are seen in many cases of left ventricular dysfunction. This study aims to evaluate the predictive utility of the Tpeak-Tend/QT interval ratio in predicting major adverse cardiac events (MACEs), such as heart failure, by examining the Tend/QT interval ratio values with NT-proBNP in STEMI. Methodology This cross-sectional study was conducted at a tertiary hospital between April 2024 and June 2024. It included STEMI patients, excluding those with non-STEMI (NSTEMI), valvular heart diseases, bundle branch block, or pacemakers. The patients with a Tpeak-Tend/QT ratio < 0.3 were included in group A, and the Tpeak-Tend/QT ratio > 0.3 in group B. They were monitored for MACE-like heart failure during hospitalization and were compared with a study of the Tpeak-Tend/QT interval ratio in predicting heart failure in STEMI and its correlation with NT-proBNP levels. Results In this study, out of 45 patients, male predominance was observed, with 35 (78%) being men and 10 (22%) being women. In group A, the most common age group was 60-70 years, with 16 (51%) patients; in Group B, it was 50-60 years, with six (42.8%) patients. Out of 31 patients in group A, 25 were male, and six were female. In group B, out of 14 patients, 10 were male, and four were female. In this study, out of the 45 patients included, 12 (85%) among 14 patients who had MACEs like heart failure had a Tpeak-Tend/QT interval ratio of more than 0.3, and their measured NT-proBNP levels were also more than 900 pg/mL, thus showing a statistically significant association between Tpeak-Tend/QT interval ratio and NT-proBNP. Conclusion The present study showed an increased Tpeak-Tend/QT interval ratio and NT-proBNP in patients who developed heart failure in STEMI. As ECG is a readily available and affordable tool, the Tpeak-Tend/QT interval ratio can be used along with conventional markers like NT-proBNP to predict MACE in patients with STEMI.

Effect of weaning strategies on biosynthesis of oxylipids in Holstein dairy calves

The aim of this study was to determine the effect of the weaning calves at 2 ages (early vs. late) and 2 weaning paces (abrupt over 3 d vs. gradual over 14 d) on plasma oxylipids. Seventy-one dairy calves (38.8 ± 4.4 kg, body weight ± standard deviation), blocked by sex and body weight at birth, were randomly assigned in a 2 × 2 factorial arrangement of treatments. The factors were weaning age (early (6–7 weeks) vs. late (8–9 weeks)), and weaning pace (abrupt (3 weaning steps over 2 d) vs. gradual (7 weaning steps over 14 d)), generating 4 treatment groups: early-abrupt, early-gradual, late-abrupt, and late-gradual. Blood samples were collected from the jugular vein one day pre-weaning, and one day post-weaning. Oxylipids concentration was measured by liquid chromatography-tandem mass spectrometry. Fatty acid profile (including nonesterified fatty acids) was also assessed. Weaning pace, age, pace × age, body weight at birth, and sex were included as fixed effect and cohort was included as random effect in the model. Linoleic acid derivatives 13- oxooctadecadienoic (OxoODE) and 9-OxoODE had a greater concentration in calves abruptly weaned when compared with that for gradually weaned calves. Calves weaned gradually showed a greater concentration of 9- hydroxyoctadecadienoic (HODE), 13-HODE, 12,13- dihydroxyoctadecenoic (DiHOME), 9,10-DiHOME, all linoleic acid-derived compared with that for abruptly weaned calves. Anti-inflammatory oxylipid 17,18- dihydroxyeicosatrienoic (DiHETE), an eicosapentaenoic acid (EPA) derivative, was greater in calves abruptly weaned compared with gradual. Overall, pace of weaning affected the plasma concentration of oxylipids, demonstrating that weaning pace affects the oxylipids status involved in inflammation in dairy calves.

Correlation of Silage Feeds to Blood Biochemical Parameters in Saanen Goats

This paper presents the results of monitoring blood biochemical parameters of Saanen goats when using some types of silage. The study was conducted on 40 Saanen goats 6-12 months old, with an average weight of 17.5 kg, raised at the Center for Livestock Biotechnology. The goats were completely randomized in blocks into 3 treatments (NT); NT1: pseudo-silage cashew nuts, NT2: silage cassava pulp and NT3: silage corn stalks and leaves and 1 control group (using standard feed at the center). Blood samples were taken by jugular vein puncture of each animal in the morning, before feeding on days 1, 45 and 90 of the experiment. Blood biochemical indices: Glucose, Protein, Albumin, Globulin, BUN, Creatinine, AST, ALT, ALP, electrolyte index (Na, K, Ca, P) were measured by Abaxis Vetscan 2 chemical analyzer. Biochemical parameters of the control group and the 3 treatments 1, 2, 3 on the 90th day were respectively Glucose was 4.56 ± 2.86; 4.59 ± 3.84; 4.38 ± 3.88; 4.42 ± 3.18 mmol/l; Protein was 76.83 ± 8.56; 77.56 ± 6.82; 77.36 ± 7.96; 78.35 ± 8.38 g/l. The results of the evaluation of blood biochemical parameters of Saanen goats were all at normal levels when using silage rations. There was no statistical difference between the experimental and control groups. The results confirmed that the use of supplementary silage in Saanen goat farming did not affect blood biochemical indices. These data are useful for further studies on other ruminants, suggesting the use of silage in goat farming from agricultural by-products.

333. TECHNICAL CONSIDERATIONS IN UPPER-GI RECONSTRUCTION – A CASE SERIES

Abstract Background Oesophageal reconstruction post-oesophagectomy is performed for both benign and malignant pathologies. Generally, the stomach is the conduit of choice due to its simplicity, requiring only one anastomosis. However, in some cases the stomach may not be a viable option immediately or at all, and alternatives must be considered. We describe a case where the stomach was not immediately viable and two cases where alternative conduits were sought. Furthermore, we discuss techniques such as ‘supercharging’ and ‘superdrainage’ which enhance arterial flow and venous drainage respectively, in order to prevent ischaemia and related complications of the anastomosis site. Methods and Results Case 1 presents a 72-year-old with an incarcerated para-oesophageal hernia leading to necrosis of the distal oesophagus and proximal stomach. After resection, a feeding jejunostomy and a loop oesophagostomy in the neck was created. Months later, the oesophagostomy was closed, and the residual stomach was carefully mobilised into the thorax while preserving the gastro-epiploic arcade, and oesophago-gastric anastomosis was performed. Case 2 involves a 68-year-old female who had elective Nissen fundoplication for a hiatus hernia, which recurred early with strangulation of the distal oesophagus and proximal stomach requiring emergency oesophago-gastrectomy. She later underwent a colonic interposition using the left colon, with superdrainage through an anastomosis between a branch of the middle colic vein to the left external jugular vein. Case 3 describes a 61-year-old male with a gastro-oesophageal adenocarcinoma treated with an Ivor-Lewis oesophagectomy. A year later, he suffered from a strangulated diaphragmatic hernia causing necrosis of the gastric conduit. This was replaced with an isoperistaltic colonic interposition using the transverse and left colon with super drainage. Unfortunately, three years later, this was again complicated with pancreatitis and perforated gall bladder with associated ischaemia of the colonic conduit. A re-do of the colonic interposition using the right colon was done with an arterial graft between the right transverse cervical artery and branch of ileal artery and super drainage via a branch of the ileal and right external jugular veins. Conclusion Primary and in particular secondary re-constructions of the UGI tract are complex procedures and individual approaches are needed as residual anatomy varies. Consequently, such cases require meticulous planning and a multidisciplinary approach involving the cardio-thoracic, plastic and vascular surgeons and adequate support by the anaesthetic and intensive care team. Although associated with significant morbidity and mortality, reestablishment of a swallowing passage is often desired by patients to maintain quality of life.

Medium-to Long-term Outcomes of Rex Shunt in 105 Children With Extrahepatic Portal Vein Obstruction in China

PurposeThe aim of our study was to analyze the medium-to long-term outcomes of Rex shunts in a large series of children with extrahepatic portal vein obstruction (EHPVO). MethodsThe clinical data of 105 children aged between 6 months and 16 years with EHPVO who underwent Rex shunt between October 2014 and June 2021 at our center were retrospectively reviewed after more than 2 years of follow-up. ResultsThe overall patency rate of the Rex shunt was 91.43% (96/105) during a median follow-up of 41 months (range, 24–98 months). Eighty-seven (82.86%) of the 105 patients underwent classical Rex shunt with internal jugular vein (IJV) bypass, and the remaining 18 patients (17.14%) underwent modified Rex shunt with intra-abdominal vein bypass. Patients with a patent shunt experienced portal hypertension resolution, which was characterized by a reduction in portal pressure, disappearance of variceal bleeding, relief of gastroesophageal varices, and relief of splenomegaly or hypersplenism. The rate of Rex shunt thrombosis in our center was 8.57% (9/105), and a repeat Rex shunt was effective for the treatment of graft thrombosis. Anastomotic stenosis occurred in 14.26% (15/105) of the children, 38.46% (5/13) of whom received successful endovascular intervention therapy and experienced remission of portal hypertension symptoms. The patency rate of the classical Rex shunt was higher than that of the modified Rex shunt (97.70% vs. 61.11%), whereas the rate of vascular complications, including anastomotic stenosis and graft thrombosis, of the classical Rex shunt was lower than that of the modified Rex shunt (11.49% vs. 77.78%). Further comparison revealed that the risk of vascular complications was substantially greater in the modified Rex shunt group than in the classical Rex shunt group in the nonadjusted model, minimally adjusted model, and fully adjusted model (RR ranged from 6.77 to 7.07, all p < 0.001). ConclusionsThe Rex shunt provides medium-to long-term benefits for children with EHPVO. The classical Rex shunt with IJV bypass provides the best patency rate and the fewest vascular complications. Levels of EvidenceⅢ Type of StudyRetrospective comparative study.